• Internal Code :
  • Subject Code : NRSG263
  • University : Australian Catholic University
  • Subject Name : Nursing

Impact of seclusion and restrain in mental health on consumers and healthcare professionals

The issue of mental health is a major issue of concern in Australia. With an increasing incidence of reported cases, this issue has raised many eye brows to be acted upon promptly and efficiently. This healthcare issue is not restricted to any age group as well (Awaworyi, 2019). The symptoms of the same are more profound as the raise concern progresses. With this issue at its peak, there are multiple governmental and non-governmental organizations that are working to promote the interest of the individuals working in the field of mental health sector. These organization work in full spectrum to provide assistance to various stakeholders and related issues. These bodies are an integral part of the system and comprise of consumers, special needs group individuals, public and private sectors health care providers, bodies working in collaboration with state and community levels.

These collaborations aim to educate the individuals and their families, regarding the issues of mental health, factors influencing the same, policies and regulatory bodies behind this work force, conducting research in various disciplines, drafting innovative approaches and models of care for prevention and treatment of mental health illness. These collective approaches also aim at safeguarding the human rights of the individuals and their families, suffering from mental health and its related issues (Pettit, 2018). This is crucial from the point of view of implementations to be drafted, as one out of each Australian is either suffering from a mental health condition or is on the verge of getting any mental health related issue. This is also important to analyse the impact of this health-related issue on a larger group, such as a community and encompassing reforms to ensure the safety of these individuals. 

The NMHCFF (National Mental Health Consumer and Carer Forum), describes the terms of seclusion and restrains. While seclusion has been recognized as of only one type, the restrains can come in different capacities, such as physical, chemical, emotional and son on. The term of seclusion has been defined as, confinement of the consumer, during ant time of the day or night, all alone in an area or designated room, where there are no free exists. The restrains are the instruments that prevent the functioning of the person in his full capacity (Muir, 2018). The physical strains can be defined as a loss of freedom of an individual for any movements. These restrictions can be in the form of handcuffs, harnesses, straps etc. These practices are generally observed in patients that require specialist mental health care, regardless of the respective settings they are being treated in. chemical restrain can be referred as restraining through the medium of medications to the patients. These medications used in the treatment purpose are usually sedative in nature and can have the ability to control an individual’s behaviour largely. Emotional restrain can not be seen through naked eyes, it can only be observed. This is usually observed when an individual is conditioned to an extend that he loses his confidence and the ability to express his views in individual basis. They might be having an underlying fear from the healthcare service providers, which might not be actually present, in case they reveal the truth about how they feel and perceive. It is often considered of the threatening nature, from the patient point of view (Kinner, 2017).

Although there have been modulations in the regulation of these factors and upon further discussion in to this matter, chemical or pharmacological restrains have been excluded, as a common intervention technique, from the broad spectrum of mental health services. Even so, this still continues to be an integral approach of modern-day practise and has a greater impact on individuals suffering from mental health issues and undergoing treatment for the same. This used in instances where patient has to be transferred to another care facility for further treatment interventions. Although, as these restrains are involuntary and unacceptable in any form, they can have quite detrimental effects on the patients (Hochstrasser, 2018).

People with mental health related issues and their care givers, both can be observed to not advocate the restrictive practises and also nullify the possibility of any benefit from the same (Whitley, 2016). These interventions, rather than providing the patient with any comfort, compromises their rights and chances of developing a robust therapeutic relation with their healthcare providers. This method, when used for safety measures can help the healthcare providers largely. This ensures that the interventions are carried out in a contained environment, without causing harm to the affected individual as well as any other professional involved in the process (Brophy, 2016). This is also seen to enhance the efficacy of the health care provider, in terms of healthcare service delivery, to the patient. Furthermore, when opted wisely, it also prioritizes the needs of the patient on individual basis and ensures that required services are provided to him. The reporting done in these studies, is also beneficial from the point of view of collected valid and reliable information for the same, for future inferences. This data collected can also be useful in attaining a comparison between rates of incidences reported between various territories and states as well. This can enable the care providers to have a better insight to draft new and advanced reforms and agendas to improve quality of the process. These interventions can have a greater psychological impact on both patient and the care givers as well (Geoffrion, 2018).

The role of registered nurse is very important in this process. As they are the front-line medical managers responsible for the patient care and coordination, it is imperative that they contribute largely in developing reforms in safeguarding these individuals. They can also be observed in the role of advocators for the patients suffering from mental illness and can thus, contribute largely in policy and strategies making for these individuals. The nurse can work in close coordination with the healthcare providers and agencies working in this field to ensure that these redundant methodologies of seclusion and restrains are eliminated from the clinical practices. Various strategies through which nurses can take part in this functioning can be inclusive of different approaches (Labey, 2017).

The nurse can have a better accountability to promote reduction in harm causes by these interventions. This can be done proper reporting of the incidences to the concerned authorities. Currently there are no exact measures to analyse the same, but the nurses can make use of their clinical experience to identify for the short-comings and red flags of the process. Proper documentation of the same can be ensured, so that they are no information gaps left in reporting the incidence. This will enable the authorities to provide for an unbiased solution to tackle with the ongoing situation. The nurses can also make use of their evidenced- based practice to make sure that any unwanted incidents are dully noted. Their presence of mind can enable the policy makers to have a better insight in this grey area of concern (Brophy, 2016). As these seclusions and constrains of no therapeutic values, the added information in to clinical retrospective can assist the nurses to ensure smooth facilitation of the policy making of this process. This will also highlight the key performance indicators in this process and with the help of best possible resources the target of reduction and elimination of these limitations can be attained. With the help of nurses, gaining a detail of the working of the mental patients, can also be helpful in introducing practices that can be helpful in preventing and reducing the use of seclusions and restrains in clinical settings (Harrington, 2016).  

In case of use of an involuntary seclusion use, there are greater risk of harm caused to the patient. The nursing plans are usually conducted out by carrying out detailed assessment for individuals, duly noting their respective clinical findings. These findings enable the people involved in the process to formulate treatment plan as per the patient’s requirements. An inclusion of highly skilled and fundamental practise of nursing can help in mitigating the need for involuntary seclusion and restrains (Abdel, 2018). This can also be attained through the medium of following the clinical guidelines diligently and ensuring that all standards of nursing practises are met with. The nurses can also help in this process by through the means of informed care through official and authentic channels. Nurses can also assist largely in keeping the communication channels as clear as possible. This will help in resolving the conflicts through the medium of de-escalating techniques (Price, 2018).  

As the nurses’ work in a close-knit environment with the patients, they are more educated about the right so them. They can make use of this knowledge in ensuring the advocacy of the rights of these individuals on a bigger platform. They also have an insight about the ongoing mental status of an individual that is being subjected to these atrocities. Thus, the nurses can help in promoting the safeguarding of these individuals, on both personal and professional front. Nurses can adapt well too, to the various organizational changes and can get them in sync with their day-to-day clinical practises. They can also help in conducting clinical audits in regular basis to keep a close vigil on the progress of the functioning of these practises. The role of the nurse can also be determined and established on strong foundational grounds, to maintain a robust environment, that can help in reducing the stress level of the consumers. The nurses can also work in collaboration with the experts in various disciples of healthcare. By doing so they will able to provide for the patient a multidisciplinary approach of care plan. The wishes and requests of the consumers can also be taken in to due consideration and key input from them can be used in developing consumer supportive relationship. This approach can help in resolving the complex situations through the means of holistic care support plan (Harris, 2018).
In spite of highlighting the harmful effects caused by physical, emotional or chemical restrains, their use is going on in a continuous pattern, in present days as well. There are policies in place to avert such mis happenings, but there is a constant debate amongst the nurses regarding their use in the clinical practise. These mixed beliefs contain them from completely eliminating these practices from the work field of mental health. Although, the nurses don’t regard these methods as safe or necessarily favourable for the patient, in order to maintain a safe clinical practise while treating mental health patients, the use of the same becomes unavoidable. This situation will remain problematic, until these areas of concerns are identified aptly and considerable and valid alternatives are suggested to replace the ongoing clinical practises in the field of mental health. These have to be identified at both individual as well as organizational level. It is imperative to attain the reduction in use of these sources and achieve a less problematic environment. Surveys can be conducted to analyse for both patient and nurses’ perceptions on this matter and necessary actions can thus be identified to contain and reduce the use of these interventions for treatment purpose. The main focus of seclusion/restrain is reduction or complete elimination of these practices (Wright, 2018).

The effort should also be revolving around removing the barriers and the forces that prevent the enablers from carrying out this method effectively. This will also help the enablers in identifying the main areas of concerns to be worked upon. This can also be achieved by working in collaborative approach in the clinical team, ensuring strong clinical leadership, providing the task force with sufficient staff and valid resources and so on. This process will enable the functioning bodies to maintain staff and consumer safety as well. An educational effort should also be imparted to the individuals that are posted in this field of work. This will enable them to get a better insight in the subject matter. This will also enhance the attitudes of these individuals in focusing on challenging scenarios and acting in accordance with the same. This will be assistive in reducing the injury rates and increase in the staff reflection and communications skills on interpersonal basis. This will aid them in formulating norms that may be new in nature or can be a modulation of the persisting one (Moosvi, 2020).


Abdel-Hussein, N. H., & Mohamed, S. H. (2018). Effectiveaness of an Educational Program on Nurses’ Knowledge toward Restraint and Seclusion for inpatients at Psychiatric Teaching Hospitals. Indian Journal of Public Health Research & Development, 9(12), 1175-1180.
Awaworyi Churchill, S., Farrell, L., & Smyth, R. (2019). Neighbourhood ethnic diversity and mental health in Australia. Health economics, 28(9), 1075-1087.
Brophy, L. M., Roper, C. E., Hamilton, B. E., Tellez, J. J., & McSherry, B. M. (2016). Consumers’ and their supporters’ perspectives on barriers and strategies to reducing seclusion and restraint in mental health settings. Australian health review, 40(6), 599-604.
Brophy, L. M., Roper, C. E., Hamilton, B. E., Tellez, J. J., & McSherry, B. M. (2016). Consumers and their supporters’ perspectives on poor practice and the use of seclusion and restraint in mental health settings: results from Australian focus groups. International journal of mental health systems, 10(1), 6.
Geoffrion, S., Goncalves, J., Giguère, C. É., & Guay, S. (2018). Impact of a program for the management of aggressive behaviors on seclusion and restraint use in two high-risk units of a mental health institute. Psychiatric quarterly, 89(1), 95-102.
Harrington, A., Darke, H., Ennis, G., & Sundram, S. (2019). Evaluation of an alternative model for the management of clinical risk in an adult acute psychiatric inpatient unit. International journal of mental health nursing, 28(5), 1102-1112.
Harris, B., & Panozzo, G. (2019). Barriers to recovery‐focused care within therapeutic relationships in nursing: Attitudes and perceptions. International journal of mental health nursing, 28(5), 1220-1227.
Hochstrasser, L., Fröhlich, D., Schneeberger, A. R., Borgwardt, S., Lang, U. E., Stieglitz, R. D., & Huber, C. G. (2018). Long-term reduction of seclusion and forced medication on a hospital-wide level: implementation of an open-door policy over 6 years. European Psychiatry, 48(1), 51-57.
Kinner, S. A., Harvey, C., Hamilton, B., Brophy, L., Roper, C., McSherry, B., & Young, J. T. (2017). Attitudes towards seclusion and restraint in mental health settings: findings from a large, community-based survey of consumers, carers and mental health professionals. Epidemiology and psychiatric sciences, 26(5), 535-544.
Labey, M., & Noël, C. (2017). Unconstrained care: Organizational policy in a mental health center integrated into the city. L'information psychiatrique, 93(7), 563-567.
Moosvi, K., & Garbutt, S. (2020). Shifting Strategies: Using Film to Improve Therapeutic Communication and Nursing Education. Nursing education perspectives, 41(2), 134-135.
Muir‐Cochrane, E., O'Kane, D., & Oster, C. (2018). Fear and blame in mental health nurses’ accounts of restrictive practices: Implications for the elimination of seclusion and restraint. International journal of mental health nursing, 27(5), 1511-1521.
Pettit, S. A., Bowers, L., Tulloch, A., Cullen, A. E., Moylan, L. B., Sethi, F., ... & Stewart, D. (2017). Acceptability and use of coercive methods across differing service configurations with and without seclusion and/or psychiatric intensive care units. Journal of advanced nursing, 73(4), 966-976.
Price, O., Baker, J., Bee, P., & Lovell, K. (2018). The support-control continuum: An investigation of staff perspectives on factors influencing the success or failure of de-escalation techniques for the management of violence and aggression in mental health settings. International journal of nursing studies, 77, 197-206.
Whitley, K., & Rozel, J. S. (2016). Mental health care of detained youth and solitary confinement and restraint within juvenile detention facilities. Child and Adolescent Psychiatric Clinics, 25(1), 71-80.
Wright, N., & Charnock, D. (2018). Challenging oppressive practice in mental health: The development and evaluation of a video based resource for student nurses. Nurse education in practice, 33, 42-46.

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